What are the brand and generic names, dosage forms, pharmacologic categories, FDA-approved indications, dosage and frequency, mechanisms of action, contraindications, adverse effects, drug interactions, and patient counseling points for the following medications: Diabeta (Glyburide)/Glynase, Lopressor (Metoprolol)/Toprol XL, Androgel (Testosterone)/Androderm, BuSpar (Buspirone), Glucophage (Metformin), Tenormin (Atenolol)/Tenoretic, Cialis (Tadalafil), Ativan (Lorazepam), Januvia (Sitagliptin), Zebeta (Bisoprolol)/Ziac, Viagra (Sildenafil), Klonopin (Clonazepam), Onglyza (Saxagliptin), Chlorthalidone, and Estrace (Estradiol), Xanax (Alprazolam)?

Comprehensive Medication Information Guide

The following guide provides detailed information on each requested medication, including brand/generic names, dosage forms, pharmacologic categories, FDA-approved indications, dosage and frequency, mechanism of action, contraindications, adverse effects, drug interactions, and patient counseling points.

1. Diabeta/Glynase (Glyburide)

a. Brand and generic name

• Brand names: DiaBeta, Glynase PresTab
• Generic name: Glyburide

b. Dosage forms

• Tablets: 1.25 mg, 2.5 mg, 5 mg (DiaBeta)
• Micronized tablets: 1.5 mg, 3 mg, 6 mg (Glynase)

c. Pharmacologic category

• Sulfonylurea antidiabetic agent

d. FDA-approved indications

• Type 2 diabetes mellitus

e. Dosage and frequency

• Initial: 2.5-5 mg once daily (DiaBeta) or 1.5-3 mg once daily (Glynase)
• Maintenance: 1.25-20 mg daily (DiaBeta) or 0.75-12 mg daily (Glynase)
• Usually administered with breakfast or first main meal

f. Mechanism of action

• Stimulates insulin secretion from pancreatic β-cells
• Decreases hepatic glucose production
• Increases peripheral glucose uptake

g. Contraindications

• Type 1 diabetes
• Diabetic ketoacidosis
• Hypersensitivity to sulfonylureas
• Severe renal or hepatic impairment

h. Adverse effects

• Hypoglycemia (most significant)
• Weight gain
• Gastrointestinal disturbances
• Skin reactions
• Rare: blood dyscrasias, cholestatic jaundice

i. Drug interactions

• Enhanced hypoglycemic effect with: beta-blockers, MAOIs, salicylates, sulfonamides
• Decreased effect with: corticosteroids, thiazide diuretics, thyroid medications
• Alcohol may cause disulfiram-like reaction

j. Patient counseling points

• Take with first meal of the day
• Recognize and treat symptoms of hypoglycemia
• Regular blood glucose monitoring required
• Avoid alcohol consumption
• Carry identification indicating diabetes diagnosis
• Lacks durable effect on glucose lowering over time 1

2. Lopressor/Toprol XL (Metoprolol)

a. Brand and generic name

• Brand names: Lopressor (immediate-release), Toprol XL (extended-release)
• Generic name: Metoprolol tartrate (Lopressor), Metoprolol succinate (Toprol XL)

b. Dosage forms

• Immediate-release tablets: 25 mg, 50 mg, 100 mg
• Extended-release tablets: 25 mg, 50 mg, 100 mg, 200 mg
• Injectable solution: 1 mg/mL

c. Pharmacologic category

• Selective beta-1 adrenergic receptor blocker

d. FDA-approved indications

• Hypertension
• Angina pectoris
• Heart failure (extended-release)
• Post-myocardial infarction
• Atrial fibrillation (rate control) 1

e. Dosage and frequency

• Hypertension: 25-100 mg twice daily (tartrate) or 50-400 mg once daily (succinate)
• Angina: 50-200 mg twice daily (tartrate) or 100-400 mg once daily (succinate)
• Heart failure: 12.5-200 mg once daily (succinate only)
• IV administration: 2.5-5 mg bolus over 2 min, up to 3 doses 1

f. Mechanism of action

• Selectively blocks beta-1 adrenergic receptors
• Decreases heart rate and contractility
• Reduces blood pressure and myocardial oxygen demand

g. Contraindications

• Severe bradycardia
• Heart block greater than first degree
• Cardiogenic shock
• Decompensated heart failure
• Severe peripheral arterial disease

h. Adverse effects

• Fatigue, dizziness
• Bradycardia
• Hypotension
• Bronchospasm (less common than non-selective beta-blockers)
• Sleep disturbances
• Erectile dysfunction (may be partly psychological) 2

i. Drug interactions

• Additive effects with other antihypertensives
• Decreased effects with NSAIDs
• Increased risk of bradycardia with calcium channel blockers
• Masks symptoms of hypoglycemia with antidiabetic agents

j. Patient counseling points

• Do not abruptly discontinue medication
• Take with food to reduce gastrointestinal effects
• Monitor heart rate and blood pressure
• May cause dizziness; use caution when driving
• Sexual dysfunction may occur but is often psychological 2

3. Androgel/Androderm (Testosterone)

a. Brand and generic name

• Brand names: AndroGel, Androderm
• Generic name: Testosterone

b. Dosage forms

• Transdermal gel: 1%, 1.62% (AndroGel)
• Transdermal patch: 2 mg/day, 4 mg/day (Androderm)

c. Pharmacologic category

• Androgen hormone

d. FDA-approved indications

• Hypogonadism in males
• Delayed male puberty
• Gender dysphoria (in transgender males)

e. Dosage and frequency

• AndroGel 1%: 50-100 mg (5-10 g gel) applied once daily
• AndroGel 1.62%: 20.25-81 mg (1.25-5 g gel) applied once daily
• Androderm: 2-6 mg applied nightly

f. Mechanism of action

• Replaces or supplements endogenous testosterone
• Promotes development and maintenance of male sex characteristics

g. Contraindications

• Male breast cancer
• Prostate cancer
• Pregnancy (in female partners)
• Hypersensitivity to testosterone
• Severe hepatic or cardiac disease

h. Adverse effects

• Application site reactions
• Acne, oily skin
• Increased hematocrit/hemoglobin
• Gynecomastia
• Potential cardiovascular risks
• Sleep apnea
• Prostate enlargement

i. Drug interactions

• Enhanced effects of oral anticoagulants
• Altered insulin requirements in diabetic patients
• Corticosteroids may increase edema risk
• May affect laboratory test results

j. Patient counseling points

• Apply to clean, dry skin as directed
• Wash hands thoroughly after application
• Avoid skin-to-skin contact with women and children
• Cover application site with clothing
• Report any signs of prostate problems or cardiovascular symptoms
• Regular monitoring of PSA, hematocrit, and liver function required

4. BuSpar (Buspirone)

a. Brand and generic name

• Brand name: BuSpar
• Generic name: Buspirone

b. Dosage forms

• Tablets: 5 mg, 7.5 mg, 10 mg, 15 mg, 30 mg

c. Pharmacologic category

• Non-benzodiazepine anxiolytic

d. FDA-approved indications

• Management of anxiety disorders
• Short-term relief of anxiety symptoms

e. Dosage and frequency

• Initial: 7.5 mg twice daily
• Maintenance: 15-30 mg daily in divided doses
• Maximum: 60 mg daily

f. Mechanism of action

• Partial agonist at serotonin 5-HT1A receptors
• Weak dopamine D2 receptor antagonist
• Does not affect GABA receptors (unlike benzodiazepines)

g. Contraindications

• Concomitant use of MAOIs
• Severe hepatic or renal impairment
• Hypersensitivity to buspirone

h. Adverse effects

• Dizziness, headache
• Nausea
• Nervousness
• Lightheadedness
• Insomnia
• Unlike benzodiazepines, does not cause significant sedation or physical dependence 3

i. Drug interactions

• Increased blood levels with CYP3A4 inhibitors (e.g., erythromycin, ketoconazole)
• Decreased effect with CYP3A4 inducers (e.g., rifampin)
• Serotonin syndrome risk with SSRIs, MAOIs
• Grapefruit juice may increase blood levels

j. Patient counseling points

• Takes 1-2 weeks for therapeutic effect
• Not for as-needed use like benzodiazepines
• Take consistently with or without food
• Avoid alcohol consumption
• No risk of physical dependence
• Not effective for treating benzodiazepine withdrawal

5. Glucophage (Metformin)

a. Brand and generic name

• Brand name: Glucophage, Glucophage XR
• Generic name: Metformin hydrochloride

b. Dosage forms

• Immediate-release tablets: 500 mg, 850 mg, 1000 mg
• Extended-release tablets: 500 mg, 750 mg, 1000 mg
• Oral solution: 500 mg/5 mL

c. Pharmacologic category

• Biguanide antihyperglycemic agent

d. FDA-approved indications

• Type 2 diabetes mellitus
• Prevention of type 2 diabetes in high-risk individuals
• Polycystic ovary syndrome (off-label)

e. Dosage and frequency

• Initial: 500 mg twice daily or 850 mg once daily
• Maintenance: 1000-2550 mg daily in divided doses
• Extended-release: 500-2000 mg once daily

f. Mechanism of action

• Decreases hepatic glucose production
• Increases peripheral glucose uptake
• Decreases intestinal glucose absorption 4

g. Contraindications

• Renal dysfunction (eGFR <30 mL/min)
• Acute or chronic metabolic acidosis
• Hypersensitivity to metformin
• Acute conditions that may cause lactic acidosis

h. Adverse effects

• Gastrointestinal: nausea, diarrhea, abdominal discomfort
• Vitamin B12 deficiency with long-term use
• Lactic acidosis (rare but serious)
• Metallic taste

i. Drug interactions

• Increased risk of hypoglycemia with sulfonylureas and insulin
• Increased risk of lactic acidosis with iodinated contrast media
• Decreased effectiveness with corticosteroids
• Alcohol increases risk of lactic acidosis

j. Patient counseling points

• Take with meals to minimize gastrointestinal effects
• Start at low dose and gradually increase
• Monitor blood glucose regularly
• Temporary discontinuation for procedures with contrast dye
• Weight loss may occur
• Minimal risk of hypoglycemia when used alone

6. Tenormin/Tenoretic (Atenolol/Atenolol-Chlorthalidone)

a. Brand and generic name

• Brand names: Tenormin (atenolol), Tenoretic (atenolol-chlorthalidone)
• Generic names: Atenolol, Atenolol-Chlorthalidone

b. Dosage forms

• Tenormin tablets: 25 mg, 50 mg, 100 mg
• Tenoretic tablets: 50/25 mg, 100/25 mg (atenolol/chlorthalidone)

c. Pharmacologic category

• Selective beta-1 adrenergic receptor blocker (atenolol)
• Combination antihypertensive (Tenoretic)

d. FDA-approved indications

• Hypertension
• Angina pectoris
• Acute myocardial infarction
• Atrial fibrillation (rate control) 1

e. Dosage and frequency

• Hypertension: 25-100 mg once daily
• Angina: 50-100 mg once daily
• Post-MI: 100 mg once daily
• Tenoretic: One tablet daily

f. Mechanism of action

• Atenolol: Selectively blocks beta-1 adrenergic receptors
• Chlorthalidone: Inhibits sodium reabsorption in distal renal tubule

g. Contraindications

• Sinus bradycardia
• Heart block greater than first degree
• Cardiogenic shock
• Overt cardiac failure
• Hypersensitivity to components

h. Adverse effects

• Fatigue, dizziness
• Bradycardia
• Cold extremities
• Bronchospasm
• Sexual dysfunction
• Electrolyte imbalances (with chlorthalidone)

i. Drug interactions

• Calcium channel blockers: increased risk of heart block
• Clonidine: rebound hypertension if beta-blocker discontinued first
• NSAIDs: decreased antihypertensive effect
• Antidiabetic agents: may mask hypoglycemia symptoms

j. Patient counseling points

• Do not abruptly discontinue medication
• Take at the same time each day
• Monitor heart rate and blood pressure
• May cause dizziness; use caution when driving
• Avoid salt substitutes containing potassium with Tenoretic

7. Cialis (Tadalafil)

a. Brand and generic name

• Brand name: Cialis
• Generic name: Tadalafil

b. Dosage forms

• Tablets: 2.5 mg, 5 mg, 10 mg, 20 mg

c. Pharmacologic category

• Phosphodiesterase type 5 (PDE5) inhibitor

d. FDA-approved indications

• Erectile dysfunction
• Benign prostatic hyperplasia
• Pulmonary arterial hypertension (as Adcirca)

e. Dosage and frequency

• Erectile dysfunction (as needed): 10-20 mg taken prior to sexual activity
• Erectile dysfunction (daily): 2.5-5 mg once daily
• BPH: 5 mg once daily

f. Mechanism of action

• Inhibits PDE5 enzyme, preventing breakdown of cGMP
• Increases blood flow to corpus cavernosum
• Promotes penile erection in response to sexual stimulation

g. Contraindications

• Concomitant use of nitrates in any form
• Hypersensitivity to tadalafil
• Unstable angina
• Recent stroke or myocardial infarction
• Severe hepatic impairment

h. Adverse effects

• Headache
• Dyspepsia
• Back pain
• Myalgia
• Nasal congestion
• Visual disturbances
• Priapism (rare)

i. Drug interactions

• Nitrates: severe hypotension
• Alpha-blockers: enhanced hypotensive effect
• CYP3A4 inhibitors: increased tadalafil levels
• Antihypertensives: additive blood pressure-lowering effects

j. Patient counseling points

• For ED: take as needed 30 minutes before sexual activity
• For daily use: take at the same time each day
• Erection requires sexual stimulation
• Seek emergency care for erections lasting >4 hours
• Do not use with nitrates or recreational drugs containing nitrates

8. Ativan (Lorazepam)

a. Brand and generic name

• Brand name: Ativan
• Generic name: Lorazepam

b. Dosage forms

• Tablets: 0.5 mg, 1 mg, 2 mg
• Injectable solution: 2 mg/mL, 4 mg/mL
• Oral solution: 2 mg/mL

c. Pharmacologic category

• Benzodiazepine
• Anxiolytic
• Sedative-hypnotic
• Anticonvulsant

d. FDA-approved indications

• Anxiety disorders
• Insomnia due to anxiety
• Status epilepticus (injectable form)
• Pre-operative sedation

e. Dosage and frequency

• Anxiety: 1-3 mg/day in 2-3 divided doses
• Insomnia: 2-4 mg at bedtime
• Status epilepticus: 4 mg IV

f. Mechanism of action

• Enhances the effect of GABA at GABA-A receptors
• Increases chloride ion channel opening frequency
• Produces CNS depression 4

g. Contraindications

• Acute narrow-angle glaucoma
• Severe respiratory insufficiency
• Sleep apnea
• Severe hepatic impairment
• Hypersensitivity to benzodiazepines

h. Adverse effects

• Sedation, drowsiness
• Dizziness, ataxia
• Cognitive impairment
• Respiratory depression
• Physical and psychological dependence
• Anterograde amnesia

i. Drug interactions

• CNS depressants: enhanced sedative effects
• CYP3A4 inhibitors: increased lorazepam effect
• Alcohol: enhanced CNS depression
• Opioids: increased risk of severe sedation and respiratory depression

j. Patient counseling points

• Avoid alcohol and other CNS depressants
• Do not abruptly discontinue after prolonged use
• May impair ability to drive or operate machinery
• Risk of dependence with prolonged use
• Store securely away from others
• Take exactly as prescribed

9. Januvia (Sitagliptin)

a. Brand and generic name

• Brand name: Januvia
• Generic name: Sitagliptin

b. Dosage forms

• Tablets: 25 mg, 50 mg, 100 mg

c. Pharmacologic category

• Dipeptidyl peptidase-4 (DPP-4) inhibitor
• Antidiabetic agent

d. FDA-approved indications

• Type 2 diabetes mellitus

e. Dosage and frequency

• 100 mg once daily
• Dose adjustment for renal impairment:
  • eGFR 30-45 mL/min: 50 mg once daily
  • eGFR <30 mL/min: 25 mg once daily

f. Mechanism of action

• Inhibits DPP-4 enzyme
• Increases incretin levels (GLP-1 and GIP)
• Stimulates insulin release and decreases glucagon secretion in a glucose-dependent manner 1

g. Contraindications

• Type 1 diabetes
• Diabetic ketoacidosis
• History of serious hypersensitivity to sitagliptin

h. Adverse effects

• Upper respiratory tract infection
• Nasopharyngitis
• Headache
• Rare: pancreatitis
• Rare: hypersensitivity reactions
• Joint pain

i. Drug interactions

• Few significant drug interactions
• Increased risk of hypoglycemia when used with sulfonylureas or insulin 1

j. Patient counseling points

• Take with or without food
• Monitor blood glucose regularly
• Report symptoms of pancreatitis (severe abdominal pain)
• Continue diet and exercise program
• Low risk of hypoglycemia when used alone

10. Zebeta/Ziac (Bisoprolol/Bisoprolol-Hydrochlorothiazide)

a. Brand and generic name

• Brand names: Zebeta (bisoprolol), Ziac (bisoprolol-hydrochlorothiazide)
• Generic names: Bisoprolol fumarate, Bisoprolol-Hydrochlorothiazide

b. Dosage forms

• Zebeta tablets: 5 mg, 10 mg
• Ziac tablets: 2.5/6.25 mg, 5/6.25 mg, 10/6.25 mg (bisoprolol/HCTZ)

c. Pharmacologic category

• Selective beta-1 adrenergic receptor blocker (bisoprolol)
• Combination antihypertensive (Ziac)

d. FDA-approved indications

• Hypertension

e. Dosage and frequency

• Zebeta: 2.5-20 mg once daily
• Ziac: One tablet once daily

f. Mechanism of action

• Bisoprolol: Selectively blocks beta-1 adrenergic receptors
• Hydrochlorothiazide: Inhibits sodium and chloride reabsorption in distal tubule

g. Contraindications

• Cardiogenic shock
• Overt cardiac failure
• Second or third-degree AV block
• Severe bradycardia
• Severe hepatic or renal impairment (for Ziac)

h. Adverse effects

• Fatigue, dizziness
• Bradycardia
• Bronchospasm
• Electrolyte imbalances (with HCTZ)
• Hyperglycemia (with HCTZ)
• Hyperlipidemia (with HCTZ)

i. Drug interactions

• Calcium channel blockers: increased risk of heart block
• Antidiabetic agents: may mask hypoglycemia symptoms
• NSAIDs: decreased antihypertensive effect
• Lithium: increased lithium levels with HCTZ

j. Patient counseling points

• Take at the same time each day
• Do not abruptly discontinue medication
• Monitor blood pressure regularly
• May cause dizziness; use caution when driving
• Report signs of electrolyte imbalance (muscle cramps, weakness)

11. Viagra (Sildenafil)

a. Brand and generic name

• Brand name: Viagra
• Generic name: Sildenafil citrate

b. Dosage forms

• Tablets: 25 mg, 50 mg, 100 mg

c. Pharmacologic category

• Phosphodiesterase type 5 (PDE5) inhibitor

d. FDA-approved indications

• Erectile dysfunction
• Pulmonary arterial hypertension (as Revatio)

e. Dosage and frequency

• 50 mg taken approximately 1 hour before sexual activity
• Range: 25-100 mg once daily as needed
• Maximum: once daily dosing

f. Mechanism of action

• Inhibits PDE5 enzyme
• Prevents breakdown of cGMP
• Increases blood flow to corpus cavernosum
• Promotes erection in response to sexual stimulation

g. Contraindications

• Concomitant use of nitrates
• Hypersensitivity to sildenafil
• Severe cardiovascular disease
• Recent stroke or myocardial infarction
• Severe hepatic impairment

h. Adverse effects

• Headache
• Flushing
• Dyspepsia
• Nasal congestion
• Visual disturbances (blue-tinged vision)
• Priapism (rare)

i. Drug interactions

• Nitrates: severe hypotension
• Alpha-blockers: enhanced hypotensive effect
• CYP3A4 inhibitors: increased sildenafil levels
• Antihypertensives: additive blood pressure-lowering effects

j. Patient counseling points

• Take approximately 1 hour before sexual activity
• Erection requires sexual stimulation
• Effectiveness may be delayed with high-fat meal
• Seek emergency care for erections lasting >4 hours
• Do not use with nitrates or recreational drugs containing nitrates

12. Klonopin (Clonazepam)

a. Brand and generic name

• Brand name: Klonopin
• Generic name: Clonazepam

b. Dosage forms

• Tablets: 0.5 mg, 1 mg, 2 mg
• Orally disintegrating tablets: 0.125 mg, 0.25 mg, 0.5 mg, 1 mg, 2 mg

c. Pharmacologic category

• Benzodiazepine
• Anticonvulsant
• Anxiolytic

d. FDA-approved indications

• Seizure disorders
• Panic disorder
• Anxiety disorders

e. Dosage and frequency

• Seizures: 1.5 mg/day in 3 divided doses, maximum 20 mg/day
• Panic disorder: Initial 0.25 mg twice daily, maximum 4 mg/day
• Anxiety: 0.25-0.5 mg three times daily

f. Mechanism of action

• Enhances the effect of GABA at GABA-A receptors
• Increases frequency of chloride ion channel opening
• Produces CNS depression 4

g. Contraindications

• Significant liver disease
• Acute narrow-angle glaucoma
• Hypersensitivity to benzodiazepines

h. Adverse effects

• Sedation, drowsiness
• Ataxia, dizziness
• Cognitive impairment
• Depression
• Physical and psychological dependence
• Respiratory depression

i. Drug interactions

• CNS depressants: enhanced sedative effects
• CYP3A4 inhibitors: increased clonazepam effect
• Alcohol: enhanced CNS depression
• Opioids: increased risk of severe sedation and respiratory depression

j. Patient counseling points

• Avoid alcohol and other CNS depressants
• Do not abruptly discontinue after prolonged use
• May impair ability to drive or operate machinery
• Risk of dependence with prolonged use
• Store securely away from others
• Take exactly as prescribed

13. Onglyza (Saxagliptin)

a. Brand and generic name

• Brand name: Onglyza
• Generic name: Saxagliptin

b. Dosage forms

• Tablets: 2.5 mg, 5 mg

c. Pharmacologic category

• Dipeptidyl peptidase-4 (DPP-4) inhibitor
• Antidiabetic agent

d. FDA-approved indications

• Type 2 diabetes mellitus

e. Dosage and frequency

• 2.5-5 mg once daily
• 2.5 mg once daily for renal impairment (CrCl ≤50 mL/min)

f. Mechanism of action

• Inhibits DPP-4 enzyme
• Increases incretin levels (GLP-1 and GIP)
• Stimulates insulin release and decreases glucagon secretion in a glucose-dependent manner 1

g. Contraindications

• History of serious hypersensitivity to saxagliptin
• Type 1 diabetes
• Diabetic ketoacidosis

h. Adverse effects

• Upper respiratory tract infection
• Urinary tract infection
• Headache
• Peripheral edema
• Rare: pancreatitis
• Rare: serious hypersensitivity reactions
• Potential increased risk of heart failure 1

i. Drug interactions

• Strong CYP3A4/5 inhibitors: reduce saxagliptin dose to 2.5 mg
• Increased risk of hypoglycemia when used with sulfonylureas or insulin

j. Patient counseling points

• Take with or without food
• Monitor blood glucose regularly
• Report symptoms of heart failure (shortness of breath, swelling)
• Report symptoms of pancreatitis (severe abdominal pain)
• Continue diet and exercise program

14. Chlorthalidone

a. Brand and generic name

• Brand names: Hygroton (discontinued in US), Thalitone
• Generic name: Chlorthalidone

b. Dosage forms

• Tablets: 15 mg, 25 mg, 50 mg, 100 mg

c. Pharmacologic category

• Thiazide-like diuretic
• Antihypertensive

d. FDA-approved indications

• Hypertension
• Edema associated with heart failure
• Edema associated with renal disorders

e. Dosage and frequency

• Hypertension: 12.5-25 mg once daily
• Edema: 50-100 mg once daily or intermittently
• Maximum: 200 mg/day

f. Mechanism of action

• Inhibits sodium and chloride reabsorption in distal renal tubule
• Increases excretion of sodium, chloride, and water
• Promotes vasodilation through unknown mechanisms

g. Contraindications

• Anuria
• Hypersensitivity to chlorthalidone or sulfonamides
• Severe renal dysfunction

h. Adverse effects

• Electrolyte imbalances (hypokalemia, hyponatremia)
• Hyperuricemia, gout
• Hyperglycemia
• Hyperlipidemia
• Photosensitivity
• Orthostatic hypotension

i. Drug interactions

• Lithium: increased lithium levels
• Digoxin: increased risk of digitalis toxicity due to hypokalemia
• NSAIDs: decreased diuretic effectiveness
• Antidiabetic agents: may increase blood glucose

j. Patient counseling points

• Take in the morning to prevent nighttime urination
• May cause dizziness; use caution when driving
• Monitor electrolytes periodically
• May increase blood sugar and uric acid levels
• Maintain adequate hydration
• Consider potassium supplements or potassium-rich foods

15. Estrace (Estradiol)

a. Brand and generic name

• Brand name: Estrace
• Generic name: Estradiol

b. Dosage forms

• Oral tablets: 0.5 mg, 1 mg, 2 mg
• Vaginal cream: 0.01% (0.1 mg/g)
• Transdermal patch: various strengths
• Vaginal tablets: 10 mcg

c. Pharmacologic category

• Estrogen hormone
• Hormone replacement therapy

d. FDA-approved indications

• Moderate to severe vasomotor symptoms of menopause
• Vulvar and vaginal atrophy
• Hypoestrogenism due to hypogonadism
• Prevention of postmenopausal osteoporosis

e. Dosage and frequency

• Oral: 0.5-2 mg daily
• Vaginal cream: 2-4 g daily for 1-2 weeks, then 1 g 1-3 times weekly
• Transdermal: Apply patch twice weekly

f. Mechanism of action

• Binds to estrogen receptors
• Replaces declining estrogen levels in menopause
• Reduces vasomotor symptoms
• Maintains bone density

g. Contraindications

• Undiagnosed abnormal genital bleeding
• Known or suspected breast cancer
• Active or history of venous thromboembolism
• Active or recent arterial thromboembolic disease
• Liver dysfunction or disease
• Pregnancy

h. Adverse effects

• Nausea, bloating
• Breast tenderness
• Headache
• Fluid retention
• Increased risk of endometrial cancer (without progestin)
• Increased risk of venous thromboembolism
• Increased risk of stroke

i. Drug interactions

• CYP3A4 inducers: decreased estradiol effect
• CYP3A4 inhibitors: increased estradiol effect
• Thyroid medications: altered thyroid hormone requirements
• Warfarin: altered anticoagulant effect

j. Patient counseling points

• Use lowest effective dose for shortest duration
• Report abnormal vaginal bleeding
• Increased risk of blood clots, stroke, and certain cancers
• Regular breast examinations and mammograms recommended
• For vaginal cream: use applicator provided
• For transdermal: rotate application sites

16. Xanax (Alprazolam)

a. Brand and generic name

• Brand name: Xanax
• Generic name: Alprazolam

b. Dosage forms

• Tablets: 0.25 mg, 0.5 mg, 1 mg, 2 mg
• Extended-release tablets: 0.5 mg, 1 mg, 2 mg, 3 mg
• Orally disintegrating tablets: 0.25 mg, 0.5 mg, 1 mg, 2 mg
• Oral solution: 1 mg/mL

c. Pharmacologic category

• Benzodiazepine
• Anxiolytic
• Sedative-hypnotic

d. FDA-approved indications

• Anxiety disorders
• Panic disorder with or without agoraphobia
• Anxiety associated with depression

e. Dosage and frequency

• Anxiety: 0.25-0.5 mg three times daily, maximum 4 mg/day
• Panic disorder: 0.5 mg three times daily, maximum 10 mg/day
• Extended-release: Once daily dosing

f. Mechanism of action

• Enhances the effect of GABA at GABA-A receptors
• Increases frequency of chloride ion channel opening
• Produces CNS depression 1, 4

g. Contraindications

• Acute narrow-angle glaucoma
• Concurrent use with ketoconazole or itraconazole
• Hypersensitivity to benzodiazepines
• Pregnancy (risk category D)

h. Adverse effects

• Sedation, drowsiness
• Dizziness, ataxia
• Memory impairment
• Physical and psychological dependence
• Respiratory depression
• Rebound anxiety with discontinuation

i. Drug interactions

• CYP3A4 inhibitors: significantly increased alprazolam levels
• CNS depressants: enhanced sedative effects
• Alcohol: enhanced CNS depression
• Opioids: increased risk of severe sedation and respiratory depression
• Fluvoxamine: reduce alprazolam dose by 50% 1

j. Patient counseling points

• Avoid alcohol and other CNS depressants
• Do not abruptly discontinue after prolonged use
• May impair ability to drive or operate machinery
• High potential for dependence with prolonged use
• Store securely away from others
• Take exactly as prescribed

The information provided in this guide is based on current medical guidelines and evidence. Always consult appropriate drug references and package inserts for the most up-to-date and complete information before prescribing these medications.